Let me first be clear that this article is specifically discussing “osteoarthritis”. My problems with this “diagnosis” do not carry over into the diagnoses of Rheumatoid Arthritis or Juvenile Arthritis.
A man in his late 60’s walked into my office and prophetically stated, “Doc, I finally found out what’s wrong with my shoulder! I have arthritis!” While I really like this patient, he’s one of those stubborn gentlemen who will ask me a hundred questions, seem like he’s listening, completely agree with me and understand on the way out, and then find an opposing view the next day, and all my hard work is gone. His problem was beyond obvious. He had a classic case of shoulder impingement syndrome, which is essentially inflammation and mechanical based pain either caused by or accelerated by abnormal movement of his arm and shoulder-blade. Pain woke him up at night, he was sleeping on the arm, he shrugged his shoulder blade up with every effort of movement, and he tested painful, but not weak for the rotator cuff muscles. IT WAS DEFINITELY IMPINGEMENT! So, he proceeds to visit his primary care doc, who takes an x-ray of the affected side, sees some mild and insignificant degeneration gives the dreaded “A” word diagnosis. Clearly, I was wrong. Oh wait… No, I wasn’t.
Arthritis cannot be diagnosed solely on an x-ray. It’s not just a simple finding of degenerative changes on a picture in time. Otherwise, most people after age 25 would all have “arthritis”. The way I diagnose arthritis is actually a very complex combination of interactions between bone, soft-tissue, inflammation, neurological habits, and movement patterns. Does degeneration you see on an x-ray predispose a patient to this? Absolutely. Does it mean the patient is helpless and stuck forever with pain? Should he buy stock in Tylenol or Advil quickly? NO! This is why I often hate the diagnosis. It is handed down like a death sentence. If my patient had listened only to the primary care doctor, he is really left with no options, other than to deal with the pain and use medication.
The truth in this and many other situations is that if the doctor takes x-rays on the patient’s other shoulder, he would have likely found similar, if not worse findings. He would have also found degenerative change in the spine, hips, knees, and ankles. So why was the shoulder the patient’s only complaint? According to x-ray, he was FULL of “arthritis”. I do my best to educate patients and the public that pain is not predominantly mediated by a series of degenerative changes. His pain, along with most patient’s pain, is mediated by function. There is both biomechanical pain and chemical pain. Often, when one type is there, it drags the other with it shortly after. Examples help.
Example 1: I smack you in the forearm with a hammer. The pain is chemical in nature, as the tissue begins a process of healing, nerves send signals of pain to the brain, inflammation causes chemical pain. One week later, since you’ve been protecting that forearm, you haven’t moved your elbow correctly, and now it hurts. Now it’s biomechanical.
Example 2: I immobilize your elbow to be totally straight for 5 days. You will definitely have pain when you go to move it, and likely you will have pain in your shoulder and wrist as well. They are moving either too much or not enough, the body knows this is incorrect, provides a feedback to the brain, where it then “instructs” to move your arm (biomechanical). Your elbow will invariably also swell, aggravate soft tissue, etc… (chemical.)
My patient in question was given some specific strategies to restore the movement in his arm. Mostly, I told him to pay attention to how he raised his arm, don’t sleep on it, and use ice and KinetiCream to minimize the inflammation. Guess what! It worked. In the end, we want to restore biomechanics to the joint as best as possible and minimize chemical pain. We want to do this as naturally as possible as to not cause any further insult to the body. That creates normal function, and normal function is how pain is most effectively controlled. This is why I love being a chiropractor. I get to help restore FUNCTION daily! Remember this when you hear the term “arthritis” get tossed around, whether it be about you or a loved one. While there might not be many options other than medications or surgery to “fix” degeneration that you can find on x-ray, there may be several alternatives to improve function that will improve quality of life. In the end, my guess is quality of life is more important than winning an x-ray beauty contest.
Take care of yourself, please. You only have one body. Keep it healthy.